Don’t underestimate your back pain

Dr Lui Nai Lee, a rheumatologist at Gleneagles Hospital in Singapore, once treated a patient whose stiffness in the back was so bad that he had difficulty passing water. Despite seeing a few doctors in his home country, the 46-year-old Vietnamese patient had suffered from persistent back pain for 12 years without finding any relief.

After undergoing the therapy prescribed by Dr Lui, his pain started to fade and he was able to get back to his normal life in a few days.

“I never felt better in the past 12 years,” he told Dr Lui in an attempt to express his gratitude. “I can now sleep through the night without experiencing any pain or stiffness.”

Early warning signs to be aware of

AS usually starts off with pain and stiffness in the back, but it may lead to other complications that are not related to the spine, like skin rashes, eye inflammation and bleeding from the gut. Initially, the pain is usually worse in the morning, but as the disease intensifies, it can last the entire day.

Patients commonly experience fatigue and have difficulty getting out of bed or carrying out their daily activities.

Contrary to other lower back conditions, pain does not improve after rest; therefore stopping exercise doesn’t help to ease the pain. By contrast, continuing regular exercise actually helps to reduce the stiffness in the back. However, patients need to consult a rheumatologist beforehand to ensure they follow a safe and effective workout plan. 

The culprit for the excruciating pain was ankylosing spondylitis (AS), an arthritic condition that causes inflammation of the spinal joints.  

“The condition is often delayed in diagnosis due to lack of awareness among primary care physicians,” says Dr Lui. “Back pain is very common and most of the time is due to functional or mechanical causes instead of inflammation.”

Early diagnosis is key in AS

Patients should seek the advice of a rheumatologist if they encounter gradual and persistent back pain and stiffness for several months. People who are younger than 45 years are particularly encouraged not to disregard the pain for a common backache or sports injury.

It’s important to diagnose AS in its early stages, when the condition is confined to the lower back and spine. “Early detection can lead to better outcomes and chance of recovery,” says Dr Lui.

Once the inflammation progresses, it starts affecting the entire spine as well as the hips and the knees. In the most severe cases, the bones of the spine fuse together, impairing its flexibility and occasionally causing breathing difficulties. This phase of the disease is not reversible and, in extreme cases, can lead to immobility.

Treatment options for patients with AS

A combination of medication and physiotherapy is needed to alleviate symptoms and control the progression of the disease. The main aim of medication is to reduce inflammation in the spine, thereby relieving pain and stiffness.

For mild cases, oral anti-inflammatory medications are sufficient. If the inflammation is moderate or severe, patients may be recommended a biological therapy. This is a highly efficacious treatment for patients with moderate to severe AS because it blocks specific proteins that are involved in the inflammation, like the TNF alpha or the interleukin-17 cytokines. Data from clinical studies have shown good safety results for patients undergoing biological therapy.

Overseas patients who come to Singapore for this treatment can bring the medication back home and inject it according to a specified schedule. Dr Lui encourages patients to do one follow-up every two to three months.

Unfortunately, AS is a long-term illness where patients need to receive medication for many years. Once the condition is under control however, medication can be reduced accordingly, but this varies case by case.

Dr Lui Nai Lee is a rheumatologist at Gleneagles Hospital. Previously, he was a consultant rheumatologist and physician-in-charge of the SpondyloArthritis Clinic at the Autoimmunity and Rheumatology Centre in Singapore General Hospital (SGH). Some of the conditions he treats include autoimmune conditions such as systemic lupus erythematosus (SLE or lupus), scleroderma, systemic vasculitis, and rheumatological conditions such as ankylosing spondylitis, gout, psoriatic arthritis, rheumatoid arthritis, osteoarthritis, osteoporosis and soft tissue rheumatism.

Gleneagles Hospital Singapore
6A Napier Road, Singapore 258500
Tel: +65 6735 5000
www.gleneagles.com.sg

Lui Centre for Arthritis & Rheumatology
Gleneagles Medical Centre #07-07
6 Napier Road, Singapore 258499
Tel: +65 6475 1878